Omega-3 fatty acids and the heart: New evidence, more questions

My sufferers generally ask me whether or not they need to attempt one complement or one other. Typically my reply is equivocal, as a result of for many dietary supplements we simply don’t have sufficient proof to provide a particular reply. This doesn’t imply {that a} specific affected person couldn’t profit from a selected complement; it simply means I don’t have standardized analysis to information my suggestions. Sadly, this stays true of omega-3 fatty acid dietary supplements. The outcomes of research omega-3 dietary supplements have been inconsistent, and have left each physicians and sufferers questioning what to do.

Omega-3 fatty acids present profit in REDUCE-IT trial and win FDA approval

Two major omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are discovered primarily in fish and fish oil. Omega-3s from fish and fish oil have been beneficial by the American Coronary heart Affiliation (AHA) for the previous 20 years to cut back cardiovascular occasions, like coronary heart assault or stroke, in individuals who have already got heart problems (CVD). I’ve written about and been a powerful advocate of getting omega-3s by way of weight-reduction plan, and generally by way of the usage of dietary supplements.

Over the previous yr I’ve prescribed an omega-3, bought underneath the model identify Vascepa, to my sufferers who’re at excessive danger for CVD, based mostly on proof of cardiovascular advantages. Vascepa incorporates purified EPA, and its use is predicated on good medical information from the REDUCE-IT trial. This examine enrolled over 8,000 sufferers with elevated cardiovascular danger and excessive blood triglyceride ranges. They assigned half of the examine members to obtain 2 grams of Vascepa twice a day, and assigned the opposite members a placebo (a capsule crammed with mineral oil). The outcomes confirmed a major advantage of Vascepa over the placebo. Vascepa lowered blood triglyceride ranges, however extra importantly, it lowered the variety of coronary heart assaults and strokes, the necessity for a coronary heart stenting process to open clogged arteries, and loss of life.

A subsequent meta-analysis, which included information from over 10 research, discovered fish oil omega‐3 dietary supplements lowered danger for coronary heart assault and loss of life from coronary coronary heart illness.

In December 2020, the FDA authorized the usage of Vascepa to cut back the danger of cardiovascular occasions in sure sufferers with, or at excessive danger for, CVD.

STRENGTH trial casts some doubt on omega-3 advantages

However a latest examine has raised some questions. The STRENGTH trial, revealed in JAMA, checked out a distinct formulation of omega-3 fish oil — a mix of EPA and DHA — to see if it might additionally scale back cardiovascular danger. This examine enrolled over 13,000 sufferers who had been randomized to obtain both the EPA/DHA mixture capsule or the placebo (a capsule crammed with corn oil). The trial was terminated early on account of an interim evaluation revealing no distinction between the 2 remedy teams.

We don’t know for sure why the REDUCE-IT trial confirmed a profit from omega-3s whereas the STRENGTH trial didn’t. One risk is that the completely different outcomes are because of the completely different medicine studied. REDUCE-IT studied a purified formulation of high-dose EPA, which resulted in larger EPA ranges. This was just like the outcomes of one other trial, which additionally discovered that pure EPA lowered the danger of cardiac occasions. The STRENGTH trial examined a mix of EPA and DHA. No massive examine has ever evaluated the results on cardiovascular outcomes of purified DHA alone, leaving us to wonder if DHA would possibly counteract the advantages of EPA.

The place will we stand?

Again to my sufferers who need to know if they need to be taking an omega-3 complement. With the supply of right now’s information, I might advocate a pure EPA complement, or one which incorporates extra EPA than DHA. However don’t cease there. Eat a heart-healthy weight-reduction plan, get common train, and pursue different life-style modifications which have confirmed advantages for cardiovascular well being. Within the meantime, my colleagues and I anticipate extra definitive information on the utility of omega-3 fish oil, and who would possibly profit essentially the most.

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